APTA has contributed to an effort that may help shed light on an often-overlooked facet of the opioid crisis—the impact of opioid use disorder on people with disabilities. While final directions have not been laid out, the comments are helping to shape further calls for research on some important considerations for this population, such as barriers to addiction treatment, difficulty in accessing nonpharmacological pain management, and the relationship between traumatic, disabling injury and opioid misuse.
The project is the work of the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), a branch of the US Department of Health and Human Service's Administration for Community Living (ADL). The institute hopes to use comments it received from 50 invited respondents, including APTA, to define next steps in research and education. Other groups that responded included the American Association of Nurse Practitioners, the American Psychological Association, and the National Council on Independent Living. In addition, NIDILRR sought comments from consumers, research teams, clinicians, and community organizations.
The effort is an attempt to address what NIDILRR describes as the "paucity of research focusing on people with long-term disabilities and their likelihood of developing an opioid use disorder." In an interim report, the institute identified 3 key themes that emerged from the initial call for comment. They are:
People with disabilities are more likely than the general population to misuse opioids but less likely to receive treatment. NIDILRR authors cited one study's estimation that among Medicaid beneficiaries, people with disabilities had a higher incidence of opioid use disorder than did those without a disability (6.4% vs 4.2%) but a lower rate of receiving an approved treatment medication for opioid misuses (11% vs 32%).
Barriers such as physical accessibility to treatment centers, limited insurance coverage, and policies that withhold opioid prescriptions without offering alternative pain management approaches are more prevalent among people with disabilities. In many rural areas, treatment facilities require long travel, and, once there, those with disabilities can find physical access challenging. Additionally, treatment that focuses primarily on denying or restricting the use of opioids creates treatment gaps that often can lead to secondary health issues, including blood pressure problems, heart palpitations, and falls.
People with disabilities who have had a serious traumatic injury are at greater risk for opioid poisoning. Traumatic injuries that result in long-term disability can create secondary health conditions that often are treated with opioids. Such treatment exposes this population to an even greater danger of opioid misuse and death from opioid poisoning. One study cited by NIDILRR estimated that 70%-80% of all patients with traumatic brain injuries are discharged with a prescription for an opioid.
NIDILRR says it is exploring funding opportunities "to generate new knowledge and promote its effective use to address the opioid crisis and its impact on people with disabilities." Future possible funding areas include more research on prevalence of opioid use disorder in this population, individual and environmental risk factors, factors associated with improved access to treatment, and the effects of government policies and programs on health care access and treatment.